Medical Research: What is the background for this study? What are the main findings?

Dr. Bushnell: The catalyst for the study was to see if comorbidities and the management of them might influence functional status. But, we pre-specified gender and race because we knew these could be important predictors of outcome. As it turns out, the results of our analysis did, in fact, show that gender and race were the most significant predictors of poor functional outcome.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bushnell: The take-home message is that women and minorities have poorer functional outcome after stroke, but the reasons for this outcome need to be further explored. Our model showed that we only explained 31% of the variance in SIS-16 with gender, race/ethnicity, and stroke severity, so unmeasured factors are extremely important. We could speculate from this dataset and other published data that women may be more likely to have functional deficits prior to stroke, be unmarried/widowed, live alone, or institutionalized after stroke. Non-white stroke survivors may have poorer access to care, have multiple strokes, and more comorbidities.

Medical Research: What is the background for this study? What are the main findings?

Dr.Dharod: There is a relative paucity of data regarding asymptomatic bradycardia in adults free of clinical cardiovascular disease. Are individuals with low heart rates simply healthy individuals with a non-clinically significant finding or is there a subclinical disease process? That was the question that generated this study. Until now, there had not been any research to determine if a slow heart rate contributed to the development of cardiovascular disease. We found that a heart rate (HR) of less than 50 was not associated with an elevated risk of cardiovascular disease in participants regardless of whether they were taking Heart Rate-modifying drugs, such as beta blockers and calcium channel blockers. However, we did find a potential association between bradycardia and higher mortality rates in individuals taking HR-modifying drugs.

Dr. Mahler: Care patterns for patients with acute chest pain are inefficient. Most patients presenting to US Emergency Departments (ED) with chest pain, including those at low-risk for acute coronary syndrome (ACS), are hospitalized for comprehensive cardiac testing. These evaluations cost the US health system $10-13 billion annually, but have a diagnostic yield for ACS of <10%. American College of Cardiology/ American Heart Association (ACC/AHA) guidelines recommend that low-risk patients with acute chest pain should receive serial cardiac markers followed by objective cardiac testing (stress testing or cardiac imaging). However, guideline adherent care among low-risk patients fails to accurately focus health system resources on those likely to benefit. Among low-risk patients, who have acute coronary syndrome rates less than 2%, objective cardiac testing is associated with a substantial number of false positive and non-diagnostic tests, which often lead to invasive testing. Consensus is building within the US health care system regarding the need to more efficiently evaluate patients with acute chest pain.

Medical Research: What are the main findings?

Dr. Mahler: Patients randomized to the HEART Pathway were less likely to receive stress testing or angiography within 30 days than patients in the usual care arm (an absolute reduction of 12%. P=0.048). Early discharge (discharges from the ED without stress testing or angiography) occurred in 39.7% of patients in the HEART Pathway arm compared to 18.4%: an absolute increase of 21.3% (p<0.001). Patients in the HEART Pathway group had a median LOS of 9.9 hours compared to 21.9 hours in the usual care group: a median reduction in LOS of 12 hours (p=0.013). These reductions in utilization outcomes were accomplished without missing adverse cardiac events or increasing cardiac-related ED visits or non-index hospitalizations.

The HEART Pathway, which combines the HEART score, with 0- and 3-hour cardiac troponin tests, is an accelerated diagnostic protocol (ADP), which may improve the value of chest pain care by identify patients who can safely be discharged from the ED without stress testing or angiography. Observational studies have demonstrated that the HEART Pathway can classify >20% of patients with acute chest pain for early discharge while maintaining a negative predictive value (NPV) for major adverse cardiac event (MACE) rate of greater than 99% at 30 days. However, prior to this study the real-time use of the HEART Pathway had never been compared with usual care. Therefore, we designed a randomized controlled trial to evaluate the efficacy of the HEART Pathway to guide providers’ testing and disposition decisions for patients with acute chest pain. The hypothesis was that the HEART Pathway would meaningfully reduce objective cardiac testing, increase early discharges, and reduce index hospital length of stay compared to usual care while maintaining high sensitivity and NPV (>99%) for MACE.

Answer: St. John’s wort (SJW), a common complementary and alternative medicine (CAM) treatment for depression, is frequently used together with drugs that may interact dangerously with it. In data from the 1993-2010 National Ambulatory Medical Care Survey, a nationally representative survey of physician visits from the National Center for Health Statistics, SJW was prescribed together with drugs such as selective serotonin reuptake inhibitors (SSRIs), benzodiazepines, warfarin, statins, digoxin, verapamil, and oral contraceptives. Using SJW together with other antidepressants may cause serotonin syndrome, a potentially fatal condition.Continue reading →

Dr. Bushnell: We found that readmitted patients were significantly more likely to have more severe strokes, and to have been hospitalized two or more times during the year prior to the initial stroke admission, independent of other clinical factors, such as congestive heart failure, heart disease, or stroke complications (pneumonia, acute renal failure).

Dr. Hughes: This study is a follow-up to our recent paper that showed a novel relationship between arterial stiffness (commonly measured by pulse wave velocity) and the presence and extent of amyloid deposition in the brain, a hallmark of Alzheimer’s disease. For this study, we repeated brain amyloid imaging (using the Pittsburgh Compound B during PET imaging) in order to look for predictors of change in amyloid over two years in n=81 elderly adults aged 80+ and free from dementia. We observed that measures of systemic arterial stiffness (e.g. brachial ankle pulse wave velocity) was strongly associated with the extent of amyloid deposition in the brain at both baseline and follow-up. The change in brain amyloid accumulation over two years resulted in an increase in in the number of participants with Alzheimer’s-like (amyloid-positive) from 45% at baseline to a surprising 75% after just two years. This change in brain amyloid accumulation over two years was strongly related to having greater central stiffness (as measured by carotid femoral pulse wave velocity). These relationships between arterial stiffness and brain amyloid deposition were independent of the effects of age, gender, body mass index, antihypertensive medication use and even current blood pressure.

A significant difference in concussion risk was found between these two helmet designs Riddell Revolution (left) and the Riddell VSR4 (right).Virginia Tech

MedicalResearch.com: What are the main findings of the study?

Dr. Rowson: We found that there were large differences in concussion risk between football helmet types. This is the first study to address this question while controlling for the number of times each helmet type was impacted.

This allowed us to compare apples to apples. For example, we’re not comparing starters who frequently get hit in one helmet type to second string players who don’t get hit as much.Continue reading →

Dr. Ferrario: A significant and unexpected difference in the hemodynamic mechanisms that account for the elevated blood pressure between untreated hypertensive men and women.

The main findings were:

“Despite there being no differences between women and men in terms of office blood pressure, heart rate and body mass index, men demonstrated lower values of pulse pressure, systemic vascular resistance, brachial artery pulse wave velocity and augmentation index. In each of the three hypertension categories, the increased blood pressure in men was associated with significant augmentations in stroke volume and cardiac output compared with women. Sex-related hemodynamic differences were associated in women with higher plasma levels of leptin, hs-CRP, plasma angiotensin II and serum aldosterone. In women but not men, hs-CRP correlated with plasma concentrations of transforming growth factor β1 (TGFβ1) and body weight; in addition, plasma TGFβ1 correlated with levels of serum vascular cell adhesion molecule 1.”Continue reading →

Dr. Soliman: Using data from the REGARDS study, one of the largest US cohorts, we examined the risk of incident myocardial infarction (MI) associated with atrial fibrillation (AF). Overall, AF was associated with almost double the risk of MI. When we adjusted for common cardiovascular risk factors and potential confounders, the risk remained significantly high; about 70% increased risk. When we looked at women, men, blacks, and whites separately, we found significant differences between races and sex. AF in women and blacks was associated with more than double the risk of MI. This compares to less than 50% increased risk of heart attack associated with AF in men and whites . So AF is basically bad for all, but the risk of MI associated with AF is more pronounced in women and blacks.Continue reading →

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